NHS-FXP5004_PfankuchLindsay_Assessment4_1
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Self-Assessment of Leadership, Collaborations, and Ethics
Lindsay Pfankuch
Capella University
Collaboration, Communication, and Case Analysis for Master’s Learners
February 19, 2023
SELF-ASSESSMENT OF LEADERSHIP, COLLABORATION, AND ETHICS
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Leadership and Collaboration Experience
Although I have only been a nurse for about five years, I have been put in many situations where I have been expected to be a leader. Whether I am leading a small group or an entire unit, I rely heavily on my ability to problem solve, understand the “big picture”, and involve my entire team. I thrive on challenges and enjoy the opportunity to make changes in my healthcare organization. I recently accepted a full-time charge nurse position on night shift in the peri-operative department. While I have not had charge nurse experience before I am excited for this new opportunity to showcase my autonomy, decision-making skills, and fresh ideas. The charge nurse that came before me was in this position for a long time and while they are still an asset to our team, it is always beneficial to have new eyes on a situation and ideas to improve and
streamline processes. My role as the night shift charge nurse includes preparing charts for each surgery for the next day, ensuring all pre-op bays are set up with the proper equipment, confirming arrival times for all patients who have surgery the next day, all the while making sure the patients in the operating room will still be recovered by the post-operative staff members and managing emergently added on cases. I am also in charge of productivity and allowing staff to leave early if there are no surgeries, calling in “on-call” staff members if emergent cases are added on, coordinating bed placement for differing levels of care throughout the hospital and managing critically ill patients while waiting for rooms to open. Each day I arrive with a fresh set of eyes to problem solve and be a resource for my team.
I have the daily opportunity to ensure the success of my teammates and each patient we interact with. Every day I work with different staff members who all have different points of view on situations, so I also can act as a mediator or “answer finder” if there is a problem we are unable
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to solve. While I do work with others each day, the majority of my time at work is spent alone, working independently overnight, as long as there are no procedures in process. I also have the unique opportunity to work with interdisciplinary teams such as the operating room staff, anesthesiologists, house/nursing supervisor, bed placement staff, environmental services, pharmacy, respiratory therapists, and staff on other units. Our team is responsible for preparing and recovering patients from surgeries, we all arrive to work with that shared purpose. However, each nurse will have a differing approach to patient care. My job as a leader is to recognize the strengths and weaknesses of my teammates while keeping them and the patients safe. My leadership style is largely transformational with aspects of charismatic and situational leadership. The benefits of these leadership styles are that I
can evaluate each situation and determine how I can best support and motivate my team depending on who I am working with. I am able to get to know each staff member and understand who needs direction, coaching, support, or delegation (Cote, 2017) in different situations. I also ensure I have frequent communication to understand their needs and how I can offer support or guidance to ensure their success. Although I do not meet with stakeholders, I do frequently meet with management and educators to understand the goals of the hospital and healthcare organization. This allows me to understand the big picture while focusing on day-to-
day tasks. I am still new to my role, but I do feel I have good ideas. Some ideas are small, such as making staffing changes when necessary or assigning nurses to patients who I think have strengths that will benefit that particular patient. I will evaluate what went well and what could have gone better, then adjust for the next time. There are other ideas I have had that could affect the entire unit, such as altering the shift start and end time for the night shift charge nurses. These
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decisions will have to go through upper management as they affect the schedule. However, there is good reason behind the change. It will help the charge nurses stick to their scheduled shifts without having to stay late each day, and this will help reduce costs for the unit. Because this change has not gone into effect yet, I am unable to determine if it was a good decision or if I should have done anything differently. I communicated this change first with other charge nurses
to evaluate if it would be beneficial for all or just for some, which the majority agreed that it would be a positive change. I then escalated this change to my manager who agreed to trial it for the next schedule period to see the impact it will make with workflow, charge nurse satisfaction, and if it will decrease the amount of overtime night shift charge nurses accrue weekly. I have discussed my new role as a charge nurse with my teammates to ensure I am a positive addition to our unit and how I can continue to improve in this role. I felt that each team member I spoke with had positive feedback regarding the steps I have already taken to lead the team. I did not, however, receive constructive criticism or negative feedback, which I value just as much as positive feedback to understand where I can improve as a leader. I believe it is a challenge for others to give criticism, especially as I am still getting to know members of my team. I do appreciate positive feedback, though, as these will be things I continue to do and build
upon to continue to support my teammates. I have seen situations in which my teammates are unmotivated by circumstances, such as an excessively busy shift or not having rooms to place patients in, therefore having to “hold” them in the peri-operative area for several hours. In these situations, I strive to ensure each staff member feels supported and understands that the end goal is to provide the best possible care for our patients, regardless of the situation we are in, which is typically out of our control. I know that when I make rounds on each staff member, they feel seen and supported, therefore I will see
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an improved work ethic and better communication as opposed to when I am unable to round on staff or become occupied with other situations. Sometimes it takes a strong leader to remind staff
of the end goal and our purpose while we are at work, and I have seen firsthand how a good leader will change the outlook of the entire team. Ethics Experience
A patient I recently cared for has multiple co-morbidities, is generally unhealthy, and has failed conservative treatment for necrosis in their lower extremity. Because this patient has many
disease processes working against them it is difficult to treat the underlying cause of the lower extremity necrosis. This patient has undergone seven surgeries in less than a month to try to salvage their leg, but thus far they have just lost a significant amount of muscle tissue and strength due to being on bedrest for prolonged periods of time after surgery. Although I understand the importance of trying to salvage their leg, there comes a point in time where every option is exhausted, and the reality of amputation must be considered. As Levitt mentions in his article “Ethical decision-making in a caring environment: The four principles and LEADS” the Four Principles include autonomy, beneficence, non-
maleficence, and justice. This patient has the right to make their own decisions after receiving informed consent, including risks and benefits, regarding next steps in their treatment plan. Healthcare workers typically work for the greater good of the patient, providing benefits to the patient, and preventing harm. However, in this situation, harm can take many forms. Subjecting the patient to multiple procedures can increase their risk of infection, increased healthcare costs, increased stress, and length of stay in the hospital. On the other hand, the patient could experience these despite multiple procedures if they were to opt for amputation instead of attempting to salvage their limb. Doctors and nurses alike promise to uphold the Hippocratic
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oath to “do no harm”, but we fail to consider what harm looks like from patient to patient. Nurses
also have a code of conduct that we are expected to follow. We fail as healthcare providers to ask
and understand each patient’s view on what harm looks like to them, and unintentionally cause harm because of our lack of understanding. In this patient’s situation, harm could take the form of a prolonged hospitalization, or it could look like a limb amputation; but it would be up to the healthcare team to ask and understand what harm looks like. Lastly, we strive to make a fair and equal environment for our patients, but each patient is experiencing a different situation, therefore fairness may look different to each person. This patient is offered the same choices of surgeons as anyone else that enters our hospital, which is fair. Patients will not be discriminated against by providers, and this patient has the right to choose a provider whose goals and values align with their own. This patient is in a difficult situation where they may have to make a choice between keeping their leg, with the risk of significant disability, or amputation which can cause other problems such as body dysmorphia due to a limb difference or mobility problems. But our job as nurses is not to make this decision for the patient, rather use the Nursing Code of Ethics to help guide the patient to make the decision for themselves while providing dignified and whole person care. The nursing code of ethics highlights nine provisions that the nurse will use to guide their
practice. According to the American Nurses Association (ANA):
“Nursing encompasses the protection, promotion, and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering, in the care of individuals, families, groups, communities, and populations. All of this is reflected, in part, in nursing’s persisting
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commitment both to the welfare of the sick, injured, and vulnerable in society and to social justice. Nurses act to change those aspects of social structures that detract from health and well-being" (
Code of ethics for Nurses, 2017). As a nurse I will always help my patients practice autonomy and independence, despite my personal views about their situation. In this situation, my role as a nurse was to help this patient understand what surgery they are having and advocating for them to ask the surgeon hard questions. Patients may be intimidated to ask the surgeon questions, but nurses are very helpful when it comes to facilitating those conversations, or translating what the doctor says into plain language. I assisted the patient to understand what was going to happen during the procedure, recovery expectations, and possible complications. My job is not to change the patient’s mind about their medical care, just to give informed consent and offer support as they need it. The ANA Code of Ethics and the LEADS both aim to promote the autonomy of and benefit of the patient, caring for illnesses and injuries while promoting health and wellbeing, which are the primary basis of my job as a nurse.
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Reference
Code of ethics for Nurses
. ANA. (2017, October 26). Retrieved February 19, 2023, from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-
for-nurses/
Cote, R. (2017). Vision of Effective Leadership.
Journal of Leadership, Accountability and Ethics, 14
(4), 52-63. http://library.capella.edu/login?
qurl=https%3A%2F
%2Fwww.proquest.com%2Fscholarly-journals%2Fvision-effective-leadership
%2Fdocview%2F1994860662%2Fse-2%3Faccountid%3D27965
Levitt D. Ethical Decision-Making in a Caring Environment: The Four Principles and LEADS. Healthcare Management Forum
. 2014;27(2):105-107. doi:10.1016/j.hcmf.2014.03.013